FAQs - ADT events Feed (HL7)

Question

Response

Admissions, transfers and discharges

Can you update an admission?

Yes. There are two ways to update an admission.

Send an A08 (Update Encounter) message with the same Visit ID - This allows you to update the time/date of the admission.

However any other changed fields (e.g location) will not be updated against the admission and will instead appear as a new ‘Updated Information’ event against the visit.

Send another A01 (Admission) message with the same Visit ID - Patient class, location, doctor names, speciality code and date/time can all be amended but sending a subsequence A01 message with the same Visit ID. No subsequent ‘update’ events will appear in PKB.

Can you update a transfer?

No.

A08 (Update Encounter) messages cannot be used to update Transfers)

Sending a second A02 (Transfer) message will just cause a new transfer to be created under the same event.  Therefore consideration should be given to whether an appropriate workflow would be to cancel the original transfer event (ADT A13) and send in the updated version.

Can you update a discharge?

Yes. There are two ways to update a discharge.

Send an A08 (Update Encounter) message with the same Visit ID - This allows you to update the time/date of the discharge.

However any other changed fields (e.g location) will not be updated against the discharge and will instead appear as a new ‘Updated Information’ event against the visit.

Send another A03 (Discharge) message with the same Visit ID - Patient class, location, doctor names, speciality code and date/time can all be amended by sending a subsequence A03 message with the same Visit ID.

Do ADT events need to be cancelled in the same order they were originally sent in?

No, even if the discharge wasn’t the last event sent, it can still be the first event cancelled.

If cancelling an entire Visit, the standard practice should always be to start by cancelling the discharge, then the transfers (with the latest transfer being cancelled first), and finally the admission.

What event time shows in the UI for admissions, transfers and discharges?

As long as it has been provided, it is the actual event time stated in the message that is used:

Admission = PV1-44

Transfer = EVN-6

Discharge = PV1.45

If one of the above timestamps has not been provided, the system will use the message timestamp in the MSH segment instead (which is mandatory).

If there are multiple transfers under an event and you send a transfer cancellation, which will get cancelled first?

The one with the latest event timestamp (usually denoted from EVN-6.1). Not the last one sent in.

Can you cancel a transfer without having to cancel the discharge first?

Yes. The discharge will remain in the UI if this is done. This may be used if a transfer was sent in error but the rest of the visit is correct.

Can you cancel an admission without cancelling the transfers and discharge first?

Yes, but there is no scenario in which this should be done. When cancelling an admission, any transfers and discharge should be cancelled first.

An admission has accidentally been cancelled on its own and the transfers and discharge are still showing on the UI. Can these be removed?

Yes, it is still possible to cancel the remaining transfers and discharge by sending A12/A13 messages, even if the admission is no longer there. 

What happens if a transfer/discharge is sent but with a different VisitID to the admission?

This is identified and show as a completely separate Visit in the PKB UI.

When Admissions, Transfers and Discharges are cancelled, do they show as cancelled in the patient’s record?

No, they are completely removed from the record with no indication that they were previously there.

Can different events for the same visit have different speciality codes and privacy labels.

Yes.The overall Visit in PKB will show which privacy label(s) have been used for associated events.

However, if multiple privacy labels have been used then users with access to only one of those privacy labels will be unable to view all events associated with a Visit.

What happens if different events for one visit have different doctors (attending, etc) stated.

All the doctors names will be listed together at the top of the visit information in PKB.

What happens if the same doctor's name is populated in multiple events for a single visit? Are they duplicated in PKB?

If the name is formatted exactly the same in each event, the name will only appear once in PKB (no duplication).

Multiple events have been sent for one visit but they have different patient classes. How is this reflected in the PKB UI?

Each individual event will show their own patient class (e.g Inpatient, Outpatient).

However the overall Visit also shows the patient class in the title. It is the class against the event with the latest date/time which will show here.

Specialty codes (Hospital Service codes) are included in the ADT messages, but I can’t see them in the PKB UI. Why is this?

The way that PKB displays speciality information for ADT events is inconsistent across different views and different event types. Sometimes the code will be displayed, sometimes the mapped description will display (if this has been configured) and sometimes the speciality is not displayed at all.

The main reason that these Speciality (Hospital Service) codes are accepted by PKB for ADT events is because they are used to apply specific Privacy Labels. (This involves the trust providing a mapping list which PKB configures against the org).

If a customer is happy for all events to default to General Health privacy label, there is little benefit in including Speciality codes in event messages.

Pre and pending admissions

What happens when a pre-admission (A05) or pending-admission (A14) message is sent to PKB?

PKB will create both an Event in the Events & Messages section in PKB, and an Appointment in the Appointments section.

There are three possible timestamps that can be added to a pre/pending admission message. Which one will be used in PKB as the admission and appointment times/dates?

There is an order of precedence that is applied:

PV2-8.1 - If present, this will be used as the admission/appointment time in PKB

EVN-3.1 - if there is no PV2 segment, the system will use the timestamp in EVN-3.1

PV1-44.1 - if neither the PV2 or the EVN timestamps are provided, the system will use the admit timestamp in the PV1 segment.

What happens if none of the above timestamps are provided in a pre/pending admission message at all?

The system will still accept the message but will show the event and appointment with the date and time provided in the MSH segment (this is a mandatory field).

Can you update a pre admission (A05) or pending admission (A14) event?

Yes. By sending another A05/A14 message with the same Visit ID, you can update the time/date, patient class, location, clinician names and privacy label (speciality) of a pre-admission event.

Can you update a pre admission (A05) or pending admission (A14) appointment?

Yes. You can update the time/date, patient class, location, privacy label (specialty) and type code of the appointments by sending in a new A05/A14 message with the same Visit ID.

Clinician details and a speciality code (Hospital Service code) have been included in the A05/A14 message. Why are they not showing against the appointment in PKB?

Clinician names and speciality codes provided in the A05/A14 messages do not appear against the appointments.

The clinician names do appear against the associated event and the speciality codes can be used to apply specific privacy labels to pre-admission events/appointments, but the codes themselves and the textual descriptions will not appear in the UI.

Can you add a subject, description and end time into the pre/pending admission appointment?

No. Unlike with SIU created appointments, ones created via A05/A14 messages cannot have these details set. The subject will be applied based on the Patient Class. The other headers will not appear at all.

Can you cancel a pre/pending admission?

Yes. Similar to the other ADT events, pre/pending admission events can be cancelled. This is done by sending either an A38 message for a pre-admission or a A27 message for pending admissions, with the same Visit ID as the original message.

Once cancelled, the Event will be completely removed from the record. However the Appointment will remain in the record but show as ‘Cancelled’.

Is there any way to see in PKB if a pre-admission or a pending-admission appointment was sent?

No, both messages are dealt with in the same way and there is nothing in the system which indicates which type of appointment was sent.